左旋肉碱在腹膜透析患者中的应用进展

Recent progresses in the application of L-carnitine in peritoneal dialysis patients

肉碱(carnitine,CN)是一种非必需氨基酸,参与长链脂肪酸向线粒体基质的转运,经β-氧化,产生能量。CN的主要来源是饮食摄入、肝脏和肾脏合成。透析患者由于摄入减少、缺乏内源性肾脏合成、经透析丢失等多种原因导致肉碱缺乏。肉碱缺乏症的症状包括红细胞生成刺激剂(erythropoiesis stimulating agents,ESAs)抵抗性贫血、肌肉无力、肌肉痉挛、低血压和血脂异常等。腹膜透析(peritoneal dialysis,PD)作为一种重要的肾脏替代治疗方式,具有保护残余肾功能、稳定血流动力学、无需血管穿刺、对日常生活影响较小等优势,被更多的终末期肾病(end-stage renal disease,ESRD)患者所接受。本文回顾左旋肉碱(L-carnitine,L-CN)在PD患者中的相关研究,从肉碱的特性、PD患者肉碱缺乏的原因及患病情况、PD患者补充左旋肉碱的疗效等方面进行综述。

Carnitine is a nonessential amino acid participating in the transport of long-chain fatty acids to mitochondrial matrix forβ-oxidation and subsequent energy production.The main sources of carnitine are dietary intake and endogenous synthesis in liver and kidney.Carnitine deficiency occurs in dialysis patients due to reduced dietary intake,lack of endogenous synthesis in kidney and dialysis loss.The symptoms of carnitine deficiency include erythropoiesis stimulating agents(ESAs)resistant anemia,muscle weakness,muscle spasm,hypotension and dyslipidemia.Peritoneal dialysis(PD)as an important renal replacement therapy has the advantages of protecting residual renal function,stabilizing hemodynamics,no need for vascular puncture,and less impact on daily life,and is accepted by most end-stage renal disease(ESRD)patients.This article reviews the relevant studies of L-carnitine in PD patients,and summarizes the characteristics of carnitine,the causes and prevalence of carnitine deficiency in PD patients,and the efficacy of L-carnitine supplementation in PD patients.